The Doctor Is In: Out of work? Ask your physician for a discount

In February, an internist in suburban New York, Dr. Richard Klein, ran an ad in a local Pennysaver advertising free medical care for existing patients who had lost their jobs and had no health insurance. Yes, I said free -- no strings attached.

Crises in malpractice insurance and reduced reimbursements for doctors over the past 10 to 20 years have left many physicians dissatisfied with their profession. Overall, medical care has also become more impersonal and, as a result, less enjoyable.

But in these tough economic times, inspiring cases like Dr. Klein'sremind me why I chose a career in medicine more than two decades ago. Most doctors, myself included, felt a calling to enter medicine because they wanted to help people.

In addition to offering free care, Dr. Klein and his colleagues at Northern Westchester Internal Medicine don't charge the uninsured for tests done in the office, such as EKGs, ultrasounds, routines X-rays or standard blood and urine testing.

Dr. Klein says he considers it a way to repay patients in tough times for their loyalty when they're financially stable. It's actually a service he began offering patients years ago after he learned that a long-time patient didn't make an appointment because he didn't have insurance. The man became gravely ill and ended up in the emergency room. "I always tell patients, I don't want you to wind up like the guy who nearly died," says Klein.

Dr. Klein has practiced medicine in the same town, Yorktown Heights, for 38 years. He estimates that in normal times about 1 percent of his practice is between jobs and insurance, but right now it's more like 6 to 7 percent, which matches the unemployment rate for New York.

"There's a lot of depression going on around town because people lost jobs or are about to," he explains. "If everyone reaches out to people who lost a job or have fallen upon bad times, it would be so uplifting for the community."

I have seen a few other news reports of offers like Dr. Klein's, including some from supposedly impersonal big corporate providers. Walgreen's (WAG) announced in late March that it would provide free basic health care services at its 341 Take Care walk-in clinics for people who had lost their jobs and health coverage, and ShopRite Pharmacies are offering anyone who is unemployed and in need of antibiotics a two-week supply for free as long as they have a prescription from their physician.

My hope is that acts of generosity like Dr. Klein's will get other doctors thinking, What can I do to help my patients hit hard by the recession?

They could start by being more proactive in asking about their patients' financial situation. Many people don't seem to realize that it's perfectly acceptable to negotiate their health bills.

As for patients, I would encourage them to simply call the office before their appointment, explain their situation and ask. Don't be afraid or embarrassed (after all, think of all the other private matters you've discussed with your physician and his staff). Discounts won't be allowed if you still have coverage and insurance is essentially covering the bill. However, even if you still have coverage but, say, the doctor is out-of-network or a specialist charging higher-than-customary fees, you may be able to get a break that reduces your co-pay. What you shouldn't do is put off a necessary visit -- because like "the guy who nearly died" that could end up costing you a lot more in the long run.

I see patients almost daily who have lost their jobs or are about to, and I approach this on a case-by-case basis. I basically charge what they can afford -- that may be nothing, or a fraction of my usual costs. I've known many of my patients for several years, I know what they do, where they live, and even how much, more or less, they earn. When my patients who work as hotel housekeepers lose their job, I know to offer a discount even if they don't ask. If it's someone who was making a high six-figure salary in finance and summers in Nantucket, it's less of an issue.

At the very least, physicians should educate themselves about the growing options for patients without health insurance, from recent changes in COBRA benefits to the expansion of S-Chip, the Children's Health Insurance Program. In addition, the economic stimulus package provided extra funding for state-sponsored health care insurance programs, and patients may not realize that they qualify.

Russell Turk, M.D., is an obstetrician and gynecologist in Fairfield County, Conn.

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